The one-year project is designed to understand why some horses treated with a new class of drugs that lower insulin develop abnormally high triglycerides.
The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) are currently the most efficient drugs to control hyperinsulinemia in horses who remain refractory to control of insulin through diet and exercise, but there is limited knowledge of the risk factors associated.
[Editor's note: Several SGLT2i medication are marketed around the world to humans as a treatment for Type 2 diabetes. Three that are often seen on American television ads are Jardiance (empagliflozin), Farxiga (dapagliflozin), and Invokana (canagliflozin). The latter will be tested on horses in the Swedish study funded by the ECIR Group.]
An increase in blood triglycerides with SGLT2i treatment appears to be an important side effect, one that warrants further investigations. The increase in triglycerides is highly variable in horses treated with SGLT2i and it is not clear why some horses experience marked increase in triglycerides while others do not.
Dr Bröjer’s research is a randomized clinical trial where horses are treated with the SGLT2i canagliflozin or placebo. “This project was designed to address these gaps in our knowledge,” he said.
Dr Bröjer’s research is a randomized clinical trial where horses are treated with the SGLT2i canagliflozin or placebo. “This project was designed to address these gaps in our knowledge,” he said.
“During the study we are investigating how canagliflozin affects the balance between the two important hormones, insulin and glucagon, and how the metabolism of fat is changed,” Dr .Bröjer explains. “By understanding which factors are responsible for the uncontrolled increase in triglycerides in some horses, veterinarians will be better prepared to prevent these side effects. The SGLT2i are a fantastic tool in the veterinarians’ treatment box, but we need better understanding of the mechanisms of the side effects and how we can prevent them before we can get the full potential of the SGLT2i ability to prevent laminitis in horses.”
“To be able to conduct this study has been a major goal for me as a research leader as well as a senior clinician treating horses with laminitis. Both the laminitis horses and the family owners of these horses are very close to my heart, and I very well understand the families’ frustration with this disease since I lost my first pony in hyperinsulinemia-associated laminitis when I was thirteen years old.” says Dr Bröjer.
He concludes, “I am very proud and honored to receive a research grant from the ECIR Group since the work by this organization has been a big inspiration for my research as well as for my clinical work with laminitis horses.”
“To be able to conduct this study has been a major goal for me as a research leader as well as a senior clinician treating horses with laminitis. Both the laminitis horses and the family owners of these horses are very close to my heart, and I very well understand the families’ frustration with this disease since I lost my first pony in hyperinsulinemia-associated laminitis when I was thirteen years old.” says Dr Bröjer.
He concludes, “I am very proud and honored to receive a research grant from the ECIR Group since the work by this organization has been a big inspiration for my research as well as for my clinical work with laminitis horses.”
Brojer's newly funded research builds on previous published work of the ECIR Group. Veterinary and research advisors Gustafson and Eleanor Kellon, VMD, co-authored scientific reports based on data provided by members of the ECIR Group, first on the use of SGLT2i in refractory hyperinsulinemia, and a second report warning of high triglycerides as a side effect.
Dr. Kellon describes current ECIR thinking. “Identifying that hypertriglyceridemia was occurring, presumably as a result of the energy crisis caused by urinary glucose loss, has allowed us to develop protocols for maximizing fat utilization, supporting aerobic energy pathways in the face of loss of glucose and likely important intermediates, and provide higher energy from easily fermentable substrates. While this has been largely successful, we still don't know exactly what is going on with the hormone glucagon and whether or not these horses are actually utilizing the mobilized fat well. This is what Dr. Bröjer’s study is designed to investigate.”
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HoofSearch is a monthly live-linked directory of new peer-reviewed research studies on all aspects of equine lameness, with special emphasis on hoof science and equine podiatry. Click here to visit hoofsearch.com and learn how you can subscribe and be part of this exciting international project. |
To learn more:
Kellon, E.M. and Gustafson, K.M., 2023. Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors. Open Veterinary Journal, 13(3), pp.365-375.
Kellon, E.M. and Gustafson, K.M., 2022. Use of the SGLT2 inhibitor canagliflozin for control of refractory equine hyperinsulinemia and laminitis. Open Veterinary Journal, 12(4), pp.511-518.
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Fran Jurga
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Kellon, E.M. and Gustafson, K.M., 2019. Possible dysmetabolic hyperferritinemia in hyperinsulinemic horses. Open Veterinary Journal, 9(4), pp.287-293.
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Fran Jurga launched Hoofcare Publishing in 1985; the Hoof Blog followed in 2005 and now contains almost 2000 articles that have been viewed more than 5 1/4 million times, at last count. Covering hoof news has taken her around the world and she's still never written an article about the same thing twice. Fran says she will never run out of stories to write about on the hoof, and thanks you for reading her articles and subscribing to her publications.
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